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Missouri State University Springfield, MO June 10-13, 2020 Students apply every taping/wrapping techniques they learned on some of the camp leaders! Students say goodbye to their new friends and hello to what could be a new piece of their future! 2020 Bear’s Athletic Training/ Sports Medicine Camp Registration Form Participant’s name:__________________________ Address:___________________________________ City:________________ State:_____ Zip:_________ T-shirt Size: XS S M L XL XXL Parent’s Name:_____________________________ Home phone( )_____________________________ Cell phone( ) ______________________________ Email:_____________________________________ Emergency contact name and number: __________________________________________ Grade for school year 2020-2021:_____________ Name of School:____________________________ Camper type: Resident or Commuter Camp Level: Level One or Level Two Gender: Male or Female Parent’s Release & Indemnity Agreement We (or) I hereby request you accept the applicaon for enrollment of ______________ in the 2020 Bear’s Athlec Training/Sports Medicine (AT/SM) Camp during the dates set forth in this applicaon, and in consideraon of your acceptance of the applicaon, we (or I) (whether one or more) hereby release the Bear’s AT/SM Camp and the Board of Governors of MSU and all their employees and agents from all claims on account of any injuries which may be sustained by our (or my) minor child while aending the 2019 Bear’s AT/SM Camp and its employees and agents for any claim which may hereaſter be presented by our (or my) minor child as a result of such injuries. I (or we) authorize and provide consent for licensed medical providers or MSU Magers Health Center physicians and staff to administer any medical procedure or treatment which may be deemed medically advisable by the aending physician including diagnosc tesng and examinaon should my child become injured or sick during the camp. Parent’s/Legal Guardian Signature:_______________ For more information: Visit our website: http://sportsmed.missouristate.edu. Or Call 417-836-8553 (phone)
